<?php
/*
 * File name : inputVerifyAddress.php
* Description : Allows the agency to input the address to be verified.
* Created By : Abhiraj Chauhan
*/
include_once "basePage.php";

class inputVerifyAddress extends basePage{
	public function input()
	{
		echo <<<INPUT
		
		<form action="verifyAddress.php" method="post">
		<table>
		<tr>
		<td>Apt/Suite/House Number</td><td><input type="text" name="apt" /></td>
		</tr>
		<tr>
		<td>Address Line</td><td><input type="text" name="add" /></td>
		</tr>
		<tr>
		<td>City</td><td><input type="text" name="city" /></td>
		</tr>
		<tr>
		<td>State</td><td><input type="text" name="state" /></td>
		</tr>
		<tr>
		<td>Zip</td><td><input type="text" name="zip"></td>
		</tr>
		<tr>
		<td><input type="submit" value="Verify Address"></td><td><input type="reset" value="Reset"></td>
		</tr>
		</table>
		</form>
		
INPUT;
	}
}

$page = new inputVerifyAddress();
$page->header();
$page->include_transalte();
$page->top_menu_agency();
$page->input();
$page->footer();

?>